Conduction disorders (CD) after transcatheter aortic valve replacement (TAVR) are a frequent complication and may lead to the need for permanent pacemaker implantation (PPI). Even so, telemetry monitoring (TM) indication and duration vary widely among centers.
This study evaluated whether an algorithm based exclusively on pre and post-procedural electrocardiographic parameters could rationalize the use of TM and shorten hospitalization while maintaining a low risk of severe arrhythmic events during hospital stay and for the following 30 days. A total of 250 consecutive patients undergoing transfemoral TAVR between February 2023 and September 2024 at a single university center were prospectively included.
Patient mean age was 80.5 ± 6.9 years (52.8% men). Prior right bundle branch block (RBBB) was present in 11.2%, and 39.2% developed new-onset left bundle branch block (LBBB) during hospitalization. Overall, 55.2% (138 patients) required TM in the ICU, mainly due to recent LBBB (n = 64).
The strategy defined 24 hours of TM for new LBBB or prior RBBB, and 48 hours for wide LBBB (>150 ms) or LBBB associated with first-degree AV block. Patients not presenting CD or progression were transferred directly to the general ward without monitoring. Procedural success rate was 98.8%. Most implanted valves were balloon-expandable (76%, Edwards Sapien 3/Sapien 3 Ultra), and 24% were self-expandable valves (Evolut R/PRO/PRO+ and Navitor).
The primary outcome was incidence of severe conduction disorders (symptomatic or requiring specific intervention such as drugs, or temporary or permanent pacemaker) occurring outside the ICU at 30 days. Secondary outcomes included overall incidence of CD, PPI need and indication, timing of rhythmic events, evolution of non PPI eligible disorders, and total hospital and ICU length of stay.
During follow-up, the primary outcome — considering only patients correctly stratified — had a 1.2% incidence (3 cases; 95% CI: 0.31–3.77). They all occurred after hospital discharge, between days 6 and 8, all requiring PPI. No severe events were recorded during hospitalization outside the ICU, and there were no deaths at 30 days.
During hospitalization, 12.8% developed complete atrioventricular block (CAVB), and 75% of these required PPI. Total PPI rate was 15.2% during hospital stay (n = 38) and 16.8% at one month (n = 42), the predominant indication being CAVB (57.8%) followed by LBBB with first-degree AV block (31.1%). In 78.6% of cases, PPI occurred within the first 48 hours. CDs not requiring PPI included 83 new LBBB, 20 first-degree AV blocks, and 8 transient CAVB.
Mean hospital stay was 2.3 ± 2.2 days, significantly shorter in patients without TM (1.43 days vs. 2.93 days; p < 0.001). ICU stay for those requiring TM had a mean of 1 day (IQR 1–2). Nearly half of patients were able to avoid ICU admission following this strategy.
Post-TAVI monitoring: impact of an ECG-based algorithm on the need for ICU and pacemaker
To conclude, this ECG-based strategy for post-TAVR monitoring indication and duration was shown safe, with no deaths or severe events during hospital stay and very low rate of late episodes (1.2%), all non-fatal and after day 6. This protocol allowed TM to be omitted in nearly half of patients and resulted in very short hospital stays without compromising safety. Although a residual risk of late conduction disorders persists, even with a normal ECG at discharge, this rationalized approach optimizes resource use and reduces the need for ICU care, with consistent clinical results, and can be implemented in high-volume centers.
Original Title: A Streamline Strategy for Indication and Length of Telemetry Monitoring After TAVR.
Reference: Antonin Fournier, Catheterization and Cardiovascular Interventions, 2025.
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